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Employment Application

  1. Other Position(s) Applied For

  2. Did you earn a diploma or GED?*

  3. Are you willing to work*

  4. By my signature placed below, I affirm under the penalty of perjury, that the information provided in this employment application (and accompanying resume, if any) is provided voluntarily, is true and complete, and I understand that any false information or significant omissions may disqualify me from further consideration for employment, and may be justification for my dismissal from employment, even if the omission or falsehood does not directly relate to my job or is not discovered for many years.*

  5. I understand that this application does not, by itself, create a contract of employment. I understand and agree that, if hired, my employment is for no definite period of time, and may, regardless of the date of payment of my wages or salary, be terminated at any time subject to the provisions of the Personnel Policy Manual as the same may be amended. I understand that no person is authorized to change any of the terms mentioned in this employment application form.*

  6. I give my permission for a complete post-offer/pre-employment physical examination, including a drug screening exam and x-rays, and I consent to the release to the City of Rifle of any and all medical information, as may be deemed necessary by the City of Rifle, in judging my capability to do the work for which I am applying.*

  7. I authorize the investigation of all statements contained in this application. I also authorize the City of Rifle to contact my present employer, past employers, and any listed references.*

  8. I authorize a search of my criminal justice record and, if required for the position for which I am applying, consent to a polygraph test and/or credit check.*

  9. I authorize any persons, schools, current employers and organizations named in this application form to provide the City of Rifle with relevant information and opinions that may be useful to the City of Rifle in making a hiring decision, and I release such persons and organizations from any legal liability for any such information furnished.*

  10. Leave This Blank:

  11. This field is not part of the form submission.